Wiki Cystoprostatectomy CPT for pathology

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kduty

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I have 5 pathology providers I code for and each of them code differently for cystoprostatectomies that come to the lab in one container. I am trying to find documentation on the correct way to code for this. I believe it should be 88309 x2 (for each organ) per CPT guidelines but half of my providers argue that is over charging. What am I missing?
 
These procedures can be challenging to code depending upon the specimens received, how they are received, and how they are reported on by the pathologist. Could you please post an example report?
 
Cystoprostatectomy

Thanks so much for your response!!
The bladder and prostate come to the lab in one container. They are grossed in separately and my pathologist's read them separately. See below.

Urinary bladder and prostate, radical cystoprostatectomy:
- Tumor Type Bladder: Residual non-invasive urothelial carcinoma
- Bladder Histologic Type: Predominantly carcinoma in situ with areas of flat carcinoma and focal papillary carcinoma (all foci are noninvasive)
- Bladder Histologic Grade: High grade.
- Bladder Tumor Site: Right bladder neck, right trigone, posterior wall, right lateral wall and anterior right wall. The only focus of papillary carcinoma is present in the anterior right wall. All area show extensive ulceration.
- Tumor Size: Approximately 5.5 cm, but exact dimensions are indeterminant.
- Tumor Configuration: Ulcerated with extensive residual carcinoma in situ, flat carcinoma and focal papillary carcinoma.
- Associated Epithelial Lesions: None.
- Microscopic Tumor Extension: No residual invasion is seen.
- Margins:
Ureteral margins: Final ureteral margins are uninvolved by carcinoma.
Distal urethral margin: Uninvolved.
Deep soft tissue margin: Uninvolved.
- Distance from closest margin: Tumor is at least 1.0 cm from the radial soft tissue margin.
- Lymphovascular Invasion: Not identified.
- Regional lymph node sampling: Pelvic.
Number of Lymph Nodes Examined: 15.
Number of Lymph Nodes Involved: 0.
- Distant Metastasis: Cannot be assessed.
- AJCC Pathologic Staging (7th edition, pTNM): ypTis ypN0
- Additional Findings: Extensive ulceration with giant cell reaction and marked chronic cystitis.


- Prostate Tumor Histologic Type: Prostatic adenocarcinoma, acinar type.
- Histologic Grade:(Total Gleason score):
(Primary pattern): 3.
(Secondary pattern): 4 (20%).
- Grade group:#2 (See comment)
- Tumor Quantitation:
Percent of prostate involved by tumor: 10%.
Size of dominant nodule: 2.5 cm in the mid left and right anterior lobe.
- Extent of invasion: Invasive carcinoma is seen extending from the left and right inferior anterior lobes up to the midportion of the left and right anterior lobes.
- Margins: Focal involvement along a length of 0.5 cm is present on the anterior surface of the mid left and right anterior lobe.
Apical: Uninvolved, Bladder Neck: Uninvolved, Anterior: Involved as indicated above, Lateral: Uninvolved, Posterolateral uninvolved, Posterior: Uninvolved.
- Extra prostatic extension: Not identified.
- Urinary bladder neck invasion: Uninvolved.
- Seminal vesicle invasion: Uninvolved.
- Perineural invasion: Not identified.
- Lymphovascular Invasion: Not identified.
- Regional lymph node sampling: Pelvic (see pelvic lymph nodes above).
- Treatment Effect: No known presurgical therapy.
- AJCC Pathologic Staging (7th edition, pTNM): pT2c.
 
First, may I recommend this resource for coding pathology: https://www.apfconnect.org/pathology-service-coding-handbook.php
Every pathology group I've worked with has used this resource and found it invaluable!

To your question, you are correct, you can code 88309 X 2, once for the bladder resection and once for the radical prostatectomy. In this case, you can also charge 88307 for the regional lymph node resection. Lymph nodes aren't considered part of a cystoprostatectomy unless it is just the ones attached to the fatty tissue around the bladder. In this case, a resection of pelvic lymph nodes is documented and supports 88307.

In some cases, the surgeon will include as a separate specimen a biopsy or a segment of the urethra or ureter and these could also be separately chargeable.

Here is a useful article about receiving specimens in one or multiple containers: http://grossing-technology.com/home...overcies-in-cpt-coding-in-surgical-pathology/

I hope that helps! :)
 
Last edited:
Thanks!

The information you provided is very valuable! We are definitely checking in to the links you provided as well.
 
What if prostate is benign?

My pathologist asked another question...What if the prostate is benign in a cystoprostatectomy? Would you code that an 88307?
 
If the prostate specimen is from a radical prostate resection, then 88309 can be used, no matter the final diagnosis. However, if the specimen is from less than a radical resection or the pathologist, for whatever reason, feels that the work was not equivalent to that of a radical resection, then 88307 is appropriate.
 
If the prostate has the seminal vesicles included in the specimen then the correct code is 88309 no matter what the final diagnosis is you are correct, but if there are no seminal vesicles in the specimen then it is coded using 88307 in our hospital. A radical resection of the prostate includes the seminal vesicles where as other resections do not include them supporting the higher 88309 charge code. It is almost like a breast specimen if it has the lymph nodes then it is an 88309 whether a simple mastectomy or not but the absence of the nodes only covers work that is contained in 88307 charge code. My disclaimer is that for the hospital I work at this is the guidelines we used as instructed by Dr. Padget. We have a membership to his website and his Pathology Coding Manual that helps us with the multiple specimens in one bucket. Hope this helps.
 
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